Background <p>Cardiac troponin T is often elevated in hemodialysis patients, even without apparent heart disease. Cardiac troponin T has been used to predict mortality and morbidity among asymptomatic dialysis patients. However, only a single retrospective study has reported that higher IV iron use was associated with higher troponin levels; therefore, it remains unclear whether IV iron therapy could influence troponin levels and thus affect patients’ outcomes.</p> Methods <p>A cross-sectional study was conducted from February 2023 to October 2024 at the dialysis unit. We included 244 patients who had been on hemodialysis for more than 3 months, were on IV iron therapy, and were aged 18 years or older. High-sensitivity troponin T level (h-cTnT) was measured before the start of the dialysis session, and patients were stratified into two groups based on h-cTnT (≤ 60 ng/L and &gt; 60 ng/L).</p> Results <p>Among 224 hemodialysis patients (137 male, 87 female; mean age of 59.96 ± 13.02 years). The average IV iron dose was 255.5 ± 143.0&#xa0;mg/month. hs-TnT levels averaged 90.5 ± 89.4 ng/L, with 58.5% (131 patients) have h-cTnT level &gt; 60 ng/L. No significant relationship between IV iron and h-cTnT was found. However, higher h-cTnT levels were significantly associated with male gender, age, ischemic heart disease, cerebrovascular accidents, statin use, and doxazosin. The &gt; 60 ng/L group had a significantly lower processed blood volume (<i>p</i> = 0.038), shorter effective treatment time (<i>p</i> = 0.021), and lower KT/V urea (<i>p</i> = 0.008). Albumin levels were also lower in this group (<i>p</i> = 0.018).</p> Conclusion <p>There is no statistically significant relationship between h-cTnT and IV iron. However, these results don’t eliminate the importance of IV iron therapy in hemodialysis patients.</p> Clinical trial number <p>Not applicable.</p>